At 84, Elaine Sisto is no stranger to health issues.

“I had a Whipple procedure twelve years ago,” she says, referring to an extremely complex surgical procedure to treat tumors and other disorders of the pancreas, intestine and bile duct. “My two hips, two knees and one ankle are fake, and for two years now, I’ve had peripheral neuropathy and lost control of my balance, so I have to use a walker.”

But it wasn’t until last year, when her hands had become so swollen and painful she couldn’t use them, that she came close to giving up.

“It’s like my hands were on fire, all puffed up so that my knuckles were three times their normal size,” the Chicago resident relates. “When I told my daughter about it, I started to cry. In order to use my walker, I need my hands, but if they hurt so bad, how was I going to walk? It was nearly impossible to wash or wipe myself, and I didn’t want to be a burden to my kids. I took all sorts of ibuprofen, but nothing helped.

“I was at my wits’ end,” she admits.

Even the doctors she saw in Chicago said they couldn’t — or wouldn’t — help her.

“One of them said it was just wear and tear [osteoarthritis], and there was nothing he could do,” Sisto recalls. “The other one basically said, ‘You’re old, what do you expect?’ And they gave me medications for the pain.”

Relief in the desert

Then, during a winter visit to her daughter here in the desert, a neighbor suggested that Sisto see her “nice rheumatologist at Eisenhower Health.” So last March, Sisto scheduled an appointment with Kam Newman, MD, Board Certified in Internal Medicine and Rheumatology.

“You’d think this man had no other patients because he acts like you’re the only person in the room,” Sisto says. “He listens, he looks you in the eye, and he makes sure you understand everything he says. He’s such a great doctor.”

After running extensive blood tests and taking X-rays, Dr. Newman determined that what was causing the problem in Sisto’s hands was rheumatoid arthritis (RA), not just wear and tear, or old age.

In RA, the body’s immune system, which normally protects our health by attacking foreign substances like bacteria and viruses, mistakenly attacks the joints. This triggers inflammation that causes the tissue lining the inside of joints (the synovium) to thicken, resulting in swelling and pain in and around the joints.

The golden age of rheumatology

According to the Arthritis Foundation, about 1.5 million people in the United States have RA, with nearly three times as many women having the disease as men. In women, RA most commonly begins between ages 30 and 60; in men, it often occurs later in life. Having a family member with RA increases the odds of having it yourself; however, the majority of people with RA have no family history of the disease.

“So while we can’t do anything about Ms. Sisto’s deformed joints at this point, we do have treatments that reduce inflammation, stiffness and pain,” he says.

In fact, Dr. Newman calls this the golden age of rheumatology.

“Today we have many biologics for treating the range of rheumatic diseases,” he explains. “This is a new generation of medications that target only a small portion of the immune system, and with fewer side effects and greater effectiveness than older medications like steroids, which have a lot of side effects.”

“My knuckles are half the size they were.”

In Sisto’s case, she receives a weekly subcutaneous injection (in her stomach) of methotrexate. It’s one of the most effective and widely used medications for treating RA and other inflammatory types of arthritis. She undergoes blood work every six to eight weeks to monitor her calcium levels, and liver and kidney function.

Sisto also gets a once-a-year intravenous infusion of a bone-building medication to help prevent her osteoporosis, another rheumatic disease, from worsening. “My bones are like glass,” she says.

It has made a world of difference in her daily life and outlook.

“I thought my world had ended,” she says. “I was getting so depressed before, and didn’t know what to do.

“But then I found Dr. Newman,” she continues. “My knuckles are half the size they were. And to be pain-free — to pick up a pot, brush my teeth — I can do all that now. I can get dressed, go out to lunch or to a show. I may be 84, and I may have the body of a 104-year-old, but I think like a 24-year old. It’s all due to Dr. Newman, and I am just so grateful.

“I didn’t think doctors like him existed,” she adds. “I just had to go to California to find him.”

“I had been struggling with my breathing off and on for fifteen years,” says 73-year-old Mickey Buddingh of Palm Desert, California. “We’d moved to the desert from Los Angeles, but I was still driving back and forth three days a week for my business, and the coughing and breathing just seemed to get worse in the desert.

“I went to the emergency room three or four different times, and was diagnosed at different times with pre-pneumonia or COPD,” she continues. “I’m not young and my father smoked, so I figured I just had a weakness in my lungs.”

Despite treatment with antibiotics and inhalers, her symptoms persisted.

“I still couldn’t breathe and was at the end of my rope,” she says.

A few months later, she consulted with a physician who tried another round of medications, to no avail.

“After three or four weeks, that doctor said, ‘This is not right,’ and sent me to see Dr. Perumbeti at Eisenhower,” Buddingh relates, referring to Anil Perumbeti, MD, Board Certified in Internal Medicine, Pulmonary Medicine and Critical Care Medicine.

“He treated me for a while, and I got better,” she continues. “Then I got worse, better again, then worse again. He took a sputum sample in September 2015, and another in December of that year. He told me then that he didn’t think we had been on the right path [in terms of diagnosis and treatment].

Patient Mickey Budding

“Let me tell you what we found”

“When I went to see him in January, after about a year of trying to cope, I was feeling pretty feisty because I wasn’t doing better,” Buddingh says. “And he looked me in the eye and said to me, ‘Let me tell you what we found.’”

It turns out that Buddingh had a condition called mycobacterium avium intercellulare (MAI). It’s one of a group of bacteria (mycobacterium avium complex, or MAC) related to tuberculosis. These germs are very common in food, water and soil, and almost everyone has them in their bodies. When someone has a strong immune system, they generally don’t cause problems. But people with HIV/AIDS or underlying structural lung disease are at increased risk.

Buddingh fell into neither of these at-risk categories. But MAC infections also have been observed in a third group of patients without apparent significant risk factors: women over the age of 50 (most commonly over 60), of lower body weight and non-smokers. That fit Buddingh perfectly.

A challenging diagnosis

“This is a challenging diagnosis to make,” explains Dr. Perumbeti. “There are probably 30 to 40 common things that can cause a cough; they’re all very different and involve multiple body systems. We have to work systematically to narrow down what a specific problem could be.

“What makes MAI particularly difficult to diagnose is that it’s a slow-growing organism. It can be colonizing inside the lungs for years before it’s recognized and it’s hard to grow in the petri dish,” he continues. “But through a combination of CT scans and bronchoscopy, we were finally able to identify it in Ms. Buddingh.”

“Apparently, the antibiotics I’d been taking over the years had taken care of some of my symptoms, so I’d get better for a while, but it didn’t touch what I had,” Buddingh says. “Dr. Perumbeti explained the treatment he wanted to start me on, and gave me materials to read.”

Difficult course of treatment

The treatment for MAI isn’t easy.

“It takes a long time to work, and patients must take three different antibiotics daily for six to 18 months,” Dr. Perumbeti says. “There is a small risk of some serious side effects that we monitor for regularly during treatment, including visual, liver and blood problems.”

In addition to Buddingh having frequent checkups and lab tests, he recommended that she take a probiotic to help maintain a healthy balance of the “good” bacteria in her gut during treatment.

“I’m a person who’s hardly ever been to doctors during my life, so a regimen like that seemed daunting,” she says. “And my hematologist cautioned me that the MAI treatment was worse than chemotherapy. But I have children and grandchildren, and felt I had a responsibility to care for myself. So I agreed to do the treatment.

“Well, by about the fourth week of being on the antibiotics, I wasn’t sure I could do it,” Buddingh admits. “I was also doing nebulizer treatments four to six times a day, using three other types of inhalers, and struggling to walk from room to room.

“I continued to get better and better”

“But by the fifth week, my symptoms were gone!” she says. “I could go outside and take a deep breath, and walk around the block. ‘I can do this!’ I thought, and I continued to get better and better. I never had to use another nebulizer after that fifth week.

“I had been so miserable for so long, wondering if I’d ever get well,” she continues. “But Dr. Perumbeti was so good and kind and he kept going to get to the bottom of my illness. I have great respect for him.”

Buddingh remained on the antibiotics for more than a year and after a lengthy discussion with Dr. Perumbeti, they agreed she could stop taking them in early 2017. Today, Buddingh is feeling terrific, and requires no maintenance medication. She must, however, regularly see Dr. Perumbeti and her hematologist to monitor her lungs and blood.

“Because this bug is so challenging, we don’t use the term ‘cured,’” Dr. Perumbeti explains. “It can recur quickly, in many years or never again, which is why regular monitoring is necessary.”

“The first time I went back to see Dr. Perumbeti after my symptoms cleared up, I asked him if he accepted hugs,” Buddingh says.

Being HIV-positive was the least of Peter Girardin’s problems. The former corporate executive chef had moved to Cathedral City, California from Cleveland, Ohio in 1999. Diagnosed in 2004, at which time he temporarily came out of retirement to work in the catering department at Eisenhower Health, Girardin became a client of Desert AIDS Project in Palm Springs, undergoing quarterly clinical evaluations. His viral load was undetectable. His T-cell count was more than adequate. Despite a minor stroke suffered in 2006, which marked the end of his working days, life was good. Then suddenly, a routine prostate-specific antigen (PSA) test scored off the charts. Girardin had difficulty urinating, had no energy, experienced generalized pain, and was losing weight. A biopsy revealed a dire diagnosis on November 18, 2016. “I had stage four prostate cancer,” recalls the 72-year-old. “Very depressed, I told myself, ‘Oh, my God, I’m going to die.’”

Dr. Andavolu with patient Peter Girardin

“Multiple scans were done, and they all showed that the cancer had spread to the lymph nodes and to the bones,” says Murthy Andavolu, MD, MBA, Board Certified in Medical Oncology, Hematology and Internal Medicine.

“HIV had no effect on the rapidity of Girardin’s disease’s progression,” notes Dr. Andavolu, “but the fact that the cancer had metastasized within a year of a previous, normal PSA test result indicated it was very aggressive in nature.”

Thankfully, he and his team of infusion nurses had an equally aggressive treatment in store.

A New Treatment Approach

Prostate cancer has historically been treated with two hormones — the orally administered bicalutamide and the injectable leuprolide, both of which impair the body’s production of testosterone and its adverse effects. “Recent studies done in both the United States and Europe show that the addition of chemotherapy upfront to patients with prostate cancer prolongs survival,” says Dr. Andavolu. “So that’s what we did for Mr. Girardin, and that’s why he had, I would say, a very impressive response — a near complete response.”

Initially too ill to tolerate the chemotherapy, Girardin immediately began hormone treatment under Dr. Andavolu’s care. Six sessions of chemotherapy were then scheduled at three-week intervals from December 2016 to May 2017. “He did extremely well,” says Dr. Andavolu, “with the PSA coming down to almost normal levels.”

“When I worked in catering at Eisenhower, I got to know the rhythm of the hospital and the excellent reputation of the doctors, including those at the Lucy Curci Cancer Center,” says Girardin. “The minute I met Dr. Andavolu, he just exuded confidence. If I asked him a question, he told me the answer, and it was straightforward. There was no holding punches. He told me right away, ‘You’ve got stage four prostate cancer, but this is what we’re going to do.’”

Compassionate Care

Girardin was just as impressed with the team of infusion nurses assigned to his case. “They put me at ease right away. Nothing was rushed, nothing was panicky. It was all very controlled, and again, I was well-advised as to what was happening to me.”

“Our infusion nurses are very well-trained and the most professional and compassionate you’ll find in the entire valley,” asserts Dr. Andavolu. “They’re very considerate, and they take care of their patients’ every need, from social, psychological, emotional, and logistical concerns to treatment planning and delivery.”

Today, while not cured, Girardin is once again living the good life, with no further need for chemotherapy in the foreseeable future. “He will continue hormone therapy as long as needed in terms of keeping the PSA as low as possible,” advises Dr. Andavolu. “If he starts having side effects, we can give him a little break. That’s something we can consider as needed. He will also have multiple lines of therapy options available down the road.”

“I know I’m in good hands,” concludes the grateful patient, “and that everything’s going to be okay.”

The benefits of fiber may be relegated to discussions among older adults, but the seriousness of getting enough fiber into one’s diet is a life-long challenge — and one that should get top billing. Many ailments and diseases associated with the digestive system are largely preventable, including the second leading cause of cancer death in the United States — colon cancer. Formerly regarded as a disease that mostly affects individuals aged 50 and older, there is a rise in the number of young adults being diagnosed with colon cancer. Currently, there is no colon cancer screening protocol for young people, so by the time they are symptomatic, the cancer may have been growing for years.

Skimping on fiber can lead to many conditions, including heart disease, diabetes, diverticular disease, constipation and hemorrhoids. Colon health is critical to maintaining overall health and a sense of well-being.

The colon

The colon, also called the large intestine, is the final part of the digestive system before waste (stool) moves into the rectum prior to being discharged.

Good bacteria live throughout the intestines, aiding digestion and colon health. Fresh, whole foods and fiber play an important role in the health of colon bacteria, particularly soluble fiber. Soluble fiber, which dissolves in water, forms a gel, ferments, and becomes an ideal source of nutrients for the bacteria.

What is fiber?

Many plant foods have soluble and insoluble fiber, both of which are important for maintaining optimal colon health. Fiber is the indigestible portion of plant foods (carbohydrates) that pass through the digestive system. In addition to supplying nutrients to vital colon bacteria, soluble fiber can help lower blood cholesterol and glucose levels. Examples of soluble fiber include oats, oat bran, peas, legumes, apples, carrots, barley and citrus fruits.

Insoluble fiber, which does not dissolve in water, can instead absorb water as it travels through the system, promoting regularity and helping to prevent constipation. Whole grains (especially wheat and oat bran), legumes, vegetables and brown rice are good examples of insoluble fiber.

As a general rule, legumes are packed with fiber and are protein rich and nutrient dense.

Increase fiber slowly

Increasing fiber slowly allows the body to better adjust to it. When starting any new diet regimen, consult with a physician.

Explore new recipes utilizing fiber rich foods, such as those found at 101cookbooks.com, an excellent resource listing vegetarian recipes by categories, ingredients and by season.

Daily recommendations

The recommended amount of fiber may vary depending on one’s age, health and physician recommendations, but in general, women should consume 25 to 30 grams, and men, 30 to 35 grams, per day. An example of a daily diet of 30 to 35 grams of fiber:

The third leading cause of death in the United States, chronic obstructive pulmonary disease (COPD), affects 11 million people in this country alone. Although the primary cause of COPD is smoking, a small percentage of people develop COPD due to a genetic component, alpha-1 antitrypsin deficiency, a protein lacking from birth. Long-term exposure to lung irritants such as chemical fumes or industrial dust can also cause COPD, as can chronic bronchitis.

Eisenhower Medical Center offers the unique, comprehensive Tamkin Pulmonary Wellness Program at Eisenhower Renker Wellness Center on its main campus. The benefits of pulmonary rehabilitation can feel miraculous to someone who struggles to breathe, day in and day out.

“The outcomes are so rewarding,” says Debra Fuller, RN, Coordinator, Eisenhower Rehabilitation Program. “We provide an eight-week comprehensive program of education and exercise. Participants exercise three days a week, and on two of those days, we include core classes on topics such as coping with the disease, infection control, breathing skills, nutrition, stress and panic control, traveling, activities of daily living, and more.

“When someone starts the program, we meet with them individually for about two hours. Based on the information we gather, we create a customized plan of care for that person. We also do a follow-up one-on-one session. Regardless of the stage of their disease, they’re treated individually with regard to their physical limitations and their respiratory function. ”

Pursed lip breathing for COPD

One of the most important skills participants learn through the program is pursed lip breathing. Pursed lip breathing can dramatically help those with COPD, allowing a longer exhalation to help remove stale air from inside the airways and air sacs. When stale air doesn’t move, those individuals can feel like they’re suffocating.

“We teach our participants the three Ps and the D of breathing — pursed lip breathing, pacing and posture,” explains Fuller. “The D is for diaphragmatic — deep breathing that is done by contracting the diaphragm. Air enters the lungs and the chest rises and the belly expands during this type of breathing. It’s all about retraining one’s breathing.”

According to Fuller, these lifestyle changes help the participants increase their oxygen level, allowing them to increase their level of activity and exertion.

“One of the goals of this program is to help prevent further lung infection which causes further lung damage,” says Fuller. “Exercise, education, breathing exercises and information about how to prevent lung infection greatly benefit people living with COPD.”

Other benefits of the Pulmonary Program include: reversal of anxiety and depression; increasing strength, balance and endurance; better compliance in taking medications; better quality of life; decrease in hospital stays; and often, less frequent use of a rescue inhaler through the use of breathing techniques.

Nutrition

For those with respiratory disease, optimum nutrition has a direct impact on respiratory function. Someone with respiratory disease can burn up to 10 to 17 percent more calories just breathing. Not eating enough, or eating the wrong foods, may result in malnutrition, causing changes in body mass due to protein and fat loss. These changes may decrease muscle strength and resistance, as well as decreased energy and an increasingly compromised immune system.

The nutritional component of the Pulmonary Rehabilitation program includes handouts and class discussion covering the goals of nutrition, nutritional strategies, inflammation-fighting foods, plus foods that cause or help eliminate excessive mucus — a sign that the body is in a state of agitation.

Getting into the program

Participants may enter the Pulmonary Program by getting a physician referral. If the referral is from a physician outside of Eisenhower’s Pulmonary Clinic, the patient will meet with Ronald Sneider, MD, Director, Tamkin Pulmonary Wellness Program.

“There have been a lot of studies showing that pulmonary rehabilitation helps the patient’s attitude, their feeling of self-control, and improves cardio pulmonary fitness,” says Dr. Sneider.

“Benefits include fewer hospitalizations, less morbidity due to an understanding of medications and the ability to handle flare-ups. This program has been in operation since 1976 and it has really grown and evolved.”

Patient testimonial

Participant Marianne Millican had great success in the Pulmonary Program.

“When I got to Eisenhower, I couldn’t believe what they had available to us,” says Millican. “The staff here is absolutely unbelievable — the nurses, trainers and respiratory therapists. For me, it’s been the best support group I could have. I’m from Cleveland, but no one has a program like Eisenhower.”

Millican continues to use Renker Wellness Center to maintain her exercise routine. “I think exercise is the answer. I do my breathing exercises and follow my medication regimen. My husband Jim and I feel like we landed in the right spot here at Eisenhower. I’m fortunate to have a partner like Jim, who supports me and keeps my family informed.”

According to Fuller, the Pulmonary Program participants who wish to continue exercising in the gym may join the Renker Wellness Center’s adult fitness program at a reduced rate. For those who need it, oxygen is provided while they exercise. “It’s hard to put into words what this program becomes for somebody,” explains Millican. “Considering that there is no cure for this disease and that it’s progressive…I just don’t know where I would be without it.”

For more information about Eisenhower’s Pulmonary Rehabilitation program, call 760.773.2082.